PROJECT SUMMARY There is critical need for more effective treatment strategies to address the public health crisis that exists due to the dramatic rise in prescription opioid (PO) use disorder and the underutilization of evidence- based medication-assisted treatments (MAT). The rise of opioid use in the rural South, where opioid abuse rates are highest, is alarming. Elucidation of factors that promote seeking and sustaining MAT in this population is imperative in order to improvement treatment implementation and outcomes. The aims of this project are to: (1) identify key decision factors for seeking MAT from the perspective of persons with PO use disorder entering outpatient PO treatment in a rural Southern state; (2) identify key decision factors among persons with PO use disorder enrolled in outpatient MAT for continuing/discontinuing with opioid agonist or antagonist treatment after completing detoxification; and (3) to identify and characterize individual- and contextual-level factors contributing to successful detoxification and treatment outcomes among a cohort of persons seeking MAT for PO use disorder at 16-week follow-up. To accomplish this, we will conduct a 16 week focused ethnographic study that includes in-depth qualitative interviews with 30 treatment-seeking individuals with PO use disorder who are enrolled in an ongoing clinical trial (R01DA039088) that seeks to improve treatment, retention and outcomes for PO use disorder. Given the current dearth of information regarding treatment-seeking for PO use disorder among rural PO users, qualitative methods will allow us to develop an in-depth, detailed analysis of the complexities surrounding this important decision. Findings from this study will increase our understanding of the related personal, social, and treatment-related issues that influence treatment decisions among rural PO users. These data will be invaluable as we move from understanding treatment-seeking to developing evidence-based interventions that are acceptable, promoting retention, to rural persons with PO use disorder, as they will be based on their perspectives and tailored to their needs and preferences.